Malawian midwives are taught very good practical skills and midwifery values, but as it is often hard to practise the optimal midwifery care in Western settings. the reality in low-income countries like Malawi often means reacting to situations only when they get worse. Midwifery educators in Malawi are well aware of the limitations but at the same time I encountered eagerness in learning and adapting new ways when they are seen practical.
During my exchange-visit I was involved in various types midwifery educational activities. Kamuzu College of Nursing teaches midwives in undergraduate as well as at Masters and PhD levels. Also a new cadre of midwifery technicians has been included in recent years to respond to high need of trained midwives both in towns as well as in rural health centres. The number of student intake has also annually increased and new campuses have been built to cater for the increasing numbers, but with limited number of teachers, there are major hinders when teaching practical skills. That in turn reflects to practical study phases as the hospitals where students are doing their practicals are overcrowded by patients with small number of hospital staff to attend to patients, so students learn a lot through being innovative in situations that are not always learning situations with supervisor.
I was involved with students in their community practicals. As Malawi has only few cities, the semi-urban and rural communities are in majority. As part of their studies, midwifery students do several practicals in the communities (antenatal checks, family planning and community health surveillance) to better understand the women and families they are to serve. Through interviewing and observation groups of students found needs and then planned ways to improve situations as was the case with the group pictured above who found out that in the community they were assigned to transferring of women in labour to maternity facility was a problem and they managed to arrange two bicycle ambulances to the community. Teacher and students then trained a group of community volunteers for their use and to understand the meaning of brisk transporting of labouring women with alarm signs.
Although most student midwives are interested in facility-based midwifery, in a country with large rural and semi-urban population, a focus on community midwifery is important and the field practicals clearly opened many innovative ways to learn about the ways of their future patients and clients, even when working in facility. Learning of clinical skills in clinical labs of the college are very important but due to high number of students individual attention was not easy to arrange and lack of materials also made the task harder.
Malawi's maternal and child mortality rates have decreased successfully but the growing population keep the hospitals crowded, Students trictly in supine position in bed) and with the results she gained, she moved on to bring alternatives to field with first training the co-educators who in turn will teach midwifery students and hospital midwives alike. As I am not part of Karolinska staff, I cannot directly compare with KI and Kamuzu College of Nursing, but the midwifery education and hospitals and health centres where students will be eventually working, are closely connected. But as stated earlier, limited resources create hinders to good teaching as well as to good midwifery care.
Malawian midwifery students (both undergraduate and post graduate Masters students) with whom I worked, showed great eagerness to move forward in educational and career paths. Interest in researching issues and themes midwives encountered in their care was high, but unfortunately very few had financial possibilities to go further as scholarships are hard to come by. In both Lilongwe and Blantyre maternities several midwives had observed less than optimal situations that needed correcting and went on to study alternatives that could be used to better the situations in newborn care, early breastfeeding and better positions for second stage of labour. Group discussions on these and many topics turned out fruitful also as part of my exchange teacher visit as different ways and views tend to get us to see things differently.
My teacher exchange visit thus comprised of community midwifery group discussions in health centres, facility-based sessions with newly graduated, planning sessions with staff on the use of waiting homes for pregnant mothers, reviewing of plans for Master's studies with students who have work experience and several sessions with midwifery educators on clinical skills labs as well as on creating models of teaching that could involve both the KI students and local midwifery students into joint projects.